The test includes a screen for specimen acceptability with few exceptions. The exceptions include: bronchial specimens, specimens obtained from patients less than 6 years of age, and specimens from patients reported to the laboratory as having a diagnosis of cystic fibrosis. The test also includes a direct Gram stain, isolation and identification of microorganisms, and susceptibility testing, if appropriate.
Daily, 24 hours
Gram stain: 2 hours after receipt of the specimen in the laboratory. Preliminary culture reports are available after 24 hours. Cultures with no growth or normal flora only will be finalized after 3 days. Cultures from patients reported to the laboratory as having a diagnosis of cystic fibrosis will be finalized after 7 days. Complete reports of cultures from which pathogens are isolated may take 3-10 days after receipt of the culture depending upon the nature of the microorganisms detected.
The requisition MUST state if the patient has been diagnosed with cystic fibrosis. Patients known to be leukopenic should have this indicated on the requisition.
Inappropriate specimen container, insufficient specimen volume, specimen received in a preservative, specimen consisting of excessive oropharyngeal contamination as determined by sputum screen, specimen containing food particles. If the specimen is microscopically consistent with saliva, it will be rejected. Only one specimen will be accepted per day.
Specimen should be transported as soon as possible. When transportation is delayed, refrigerate.
Normal upper respiratory flora
Inoculation of conventional culture media.
The quantity and presence of normal upper respiratory flora will be reported. Normal flora includes alpha and nonhemolytic streptococci, saprophytic Neisseria species, cogulase-negative Staphylococcus, Micrococcus species, and diphtheroids, Haemophilus spp. not influenzae, Candida spp. not cryptococcus. Potential pathogens will be isolated, identified, and susceptibility testing performed, if appropriate. Burkholderia cepacia is identified in the Clinical Microbiology Laboratory. The isolate will be forwarded to the CF Foundation reference laboratory for confirmation and genotyping. The culture report will not be finalized until the reference laboratory confirmation is complete.